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Original ArticlesAcute Kidney Injury and ICU Nephrology
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Characteristics and Outcomes of Patients Discharged Home from an Emergency Department with AKI

Rey R. Acedillo, Ron Wald, Eric McArthur, Danielle Marie Nash, Samuel A. Silver, Matthew T. James, Michael J. Schull, Edward D. Siew, Michael E. Matheny, Andrew A. House and Amit X. Garg
CJASN August 2017, 12 (8) 1215-1225; DOI: https://doi.org/10.2215/CJN.10431016
Rey R. Acedillo
*Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada;
†Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada;
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Ron Wald
‡Division of Nephrology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada;
§Institute for Clinical Evaluative Sciences, Ontario, Canada;
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Eric McArthur
§Institute for Clinical Evaluative Sciences, Ontario, Canada;
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Danielle Marie Nash
§Institute for Clinical Evaluative Sciences, Ontario, Canada;
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Samuel A. Silver
‡Division of Nephrology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada;
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Matthew T. James
‖Division of Nephrology, Department of Medicine, Foothills Hospital, Calgary, Alberta, Canada;
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Michael J. Schull
§Institute for Clinical Evaluative Sciences, Ontario, Canada;
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Edward D. Siew
¶Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for AKI Research;
**Tennessee Valley Health Services Veterans Affairs, Nashville, Tennessee
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Michael E. Matheny
¶Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for AKI Research;
**Tennessee Valley Health Services Veterans Affairs, Nashville, Tennessee
††Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee; and
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Andrew A. House
*Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada;
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Amit X. Garg
*Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada;
†Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada;
§Institute for Clinical Evaluative Sciences, Ontario, Canada;
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Abstract

Background and objectives Patients discharged home from an emergency department with AKI are not well described. This study describes their characteristics and outcomes and compares these outcomes to two referent groups.

Design, setting, participants, & measurements We conducted a population-based retrospective cohort study in Ontario, Canada from 2003 to 2012 of 6346 patients aged ≥40 years who were discharged from the emergency department with AKI (defined using serum creatinine values). We analyzed the risk of all-cause mortality, receipt of acute dialysis, and hospitalization within 30 days after discharge. We used propensity score methods to compare all-cause mortality to two referent groups. We matched 4379 discharged patients to 4379 patients who were hospitalized from the emergency department with similar AKI stage. We also matched 6188 discharged patients to 6188 patients who were discharged home from the emergency department with no AKI.

Results There were 6346 emergency department discharges with AKI. The mean age was 69 years and 6012 (95%) had stage 1, 290 (5%) had stage 2, and 44 (0.7%) had stage 3 AKI. Within 30 days, 149 (2%) (AKI stage 1: 127 [2%]; stage 2: 15 [5%]; stage 3: seven [16%]) died, 22 (0.3%) received acute dialysis, and 1032 (16%) were hospitalized. An emergency department discharge versus hospitalization with AKI was associated with lower mortality (3% versus 12%; relative risk, 0.3; 95% confidence interval, 0.2 to 0.3). An emergency department discharge with AKI versus no AKI was associated with higher mortality (2% versus 1%; relative risk, 1.6; 95% confidence interval, 1.2 to 2.0).

Conclusions Patients discharged home from the emergency department with AKI are at risk of poor 30-day outcomes. A better understanding of care in this at-risk population is warranted, as are testing strategies to improve care.

  • Acute Kidney Injury
  • Aged
  • Canada
  • Confidence Intervals
  • creatinine
  • Emergency Service, Hospital
  • hospitalization
  • Humans
  • Kidney Function Tests
  • Ontario
  • Patient Discharge
  • Propensity Score
  • renal dialysis
  • Retrospective Studies
  • Risk
  • Received October 5, 2016.
  • Accepted May 1, 2017.
  • Copyright © 2017 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 12 (8)
Clinical Journal of the American Society of Nephrology
Vol. 12, Issue 8
August 07, 2017
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Characteristics and Outcomes of Patients Discharged Home from an Emergency Department with AKI
Rey R. Acedillo, Ron Wald, Eric McArthur, Danielle Marie Nash, Samuel A. Silver, Matthew T. James, Michael J. Schull, Edward D. Siew, Michael E. Matheny, Andrew A. House, Amit X. Garg
CJASN Aug 2017, 12 (8) 1215-1225; DOI: 10.2215/CJN.10431016

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Characteristics and Outcomes of Patients Discharged Home from an Emergency Department with AKI
Rey R. Acedillo, Ron Wald, Eric McArthur, Danielle Marie Nash, Samuel A. Silver, Matthew T. James, Michael J. Schull, Edward D. Siew, Michael E. Matheny, Andrew A. House, Amit X. Garg
CJASN Aug 2017, 12 (8) 1215-1225; DOI: 10.2215/CJN.10431016
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Keywords

  • acute kidney injury
  • aged
  • Canada
  • Confidence Intervals
  • creatinine
  • Emergency Service, Hospital
  • hospitalization
  • humans
  • Kidney Function Tests
  • Ontario
  • patient discharge
  • Propensity Score
  • renal dialysis
  • Retrospective Studies
  • Risk

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